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We read with interest the article by Markmiller et al. [1] that discussed an important issue regarding time of weight bearing after cementless total hip arthroplasty. Although we agree with the conclusion drawn from their observations, we ask clarification on several points in their methods. The authors mention that they used radiographs to measure subsidence and migration postoperatively, but as radiographs are prone to errors due to patient positioning and radiograph centring [2], were any specific steps taken to ensure minimal errors, and how was radiograph uniformity ensured during follow-up? Furthermore, all measurements were done manually by an orthopaedic surgeon. Were these measurements made on radiographs or digital images? Was any specific software used for making these measurements? There are several software packages available, such as Ein-Bild-Roentgen-Analyse (EBRA) that have been validated previously [2, 3]. These are available free and are easy to use. Although Roentgen stereophotogrammetric analysis (RSA) provides the best method for making these measurements, its availability might be an issue at several centres. We would further like to know the impact of femoral anatomy (according to Dorr types) in choice of patients for cementless femoral stem and any possible difference in prosthesis migration amongst different femoral canal morphologies [4]. In our opinion, although this study makes important and valid inferences regarding the relation between weight bearing and subsidence or migration in THR, better methods could have been used to provide firmer conclusions.

international orthopaedics

Comment on: Markmiller M, Weiss T, Kreuz P, Rüter A, Konrad G. Partial weightbearing is not necessary after cementless total hip arthroplasty. Int Orthop. 2011 Aug;35(8):1139-43